CN118750062A - Endoscopic purse-line suture surgical device - Google Patents

Abstract

The present application relates to an endoscopic wallet-line suturing surgical device. A surgical stapler for applying sutures to tissue includes a first jaw and a second jaw configured to receive a staple cartridge. An actuation mechanism causes a drive member to translate distally through the first jaw and the second jaw to apply staples to the tissue so that when the stapler is activated, the combination of the suture and the staples forms a wallet-line. The staple cartridge includes a first upper portion and a second lower portion.

Description

Endoscopic purse-line suture surgical device

This application is a divisional application of Chinese patent application 201980068800.8 (PCT/US2019/056979) entitled “Endoscopic Wallet-Line Suturing Surgical Device” filed on October 18, 2019.

Background Art

Surgical anastomosis joins two hollow organs together, usually to restore continuity after resection or, less commonly, to bypass an unresectable disease process. Anastomosis is commonly performed on the following: blood vessels, including arteries and veins; the gastrointestinal tract, including the esophagus, stomach, small intestine, colon, rectum, anus, bile duct, and pancreas; or the urinary tract, including the ureters, bladder, and urethra, and the fallopian tubes.

Purse-string sutures and purse-string applicators may be used during the anastomosis process. Sutures are typically placed using a needle, stapler, or other suitable component to attach the suture to the tissue. After attachment, the ends of the sutures are held loose to pull to contract or close the tissue.

In minimally invasive procedures, such as endoscopic surgical anastomosis procedures, it would be advantageous to provide an endoscopic purse-string device that can apply purse-string sutures in a minimally invasive manner and that is compatible with robotic surgical systems.

Summary of the invention

A simplified summary of the claimed subject matter is given below in order to provide a basic understanding of some aspects of the claimed subject matter. This summary is not an exhaustive overview of the claimed subject matter. It is neither intended to identify key or important elements of the claimed subject matter nor to delineate the scope of the claimed subject matter. Its sole purpose is to present some concepts of the claimed subject matter in a simplified form as a prelude to the more detailed description that is presented later.

The present disclosure relates to a surgical stapler for applying sutures to tissue having a staple cartridge including a shuttle configured to engage a series of stapler drivers for ejecting staples upon distal translation of a drive member.

In another aspect, the present disclosure is directed to a surgical stapler for applying sutures to tissue, the surgical stapler comprising a staple cartridge having a first upper portion and a second lower portion connected by a connecting member and configured to be mounted along a longitudinal axis of an end effector.

On the other hand, the present disclosure relates to a jaw closing mechanism, which has a first link member and a second link member fixed to the first jaw and the second jaw, the first link and the second link are coupled to a first pair and a second pair of drive cables, and the first pair and the second pair of drive cables are configured to apply force to the first and second link members to cause them to rotate around a pivot pin and pass through a cam groove, the cam groove having a proximal portion for parallel closing of the jaws and a distal portion for angled closing of the jaws.

In an embodiment, a surgical stapler for applying sutures to tissue according to the present disclosure includes an elongated shaft having a distal end and a proximal end. The end effector defines a longitudinal axis and includes a first jaw and a second jaw. The first jaw and the second jaw are configured to receive a staple cartridge and move from an open position to a closed position to apply staples to the tissue so that when the stapler is activated, the suture and the staples are combined to form a wallet line with the tissue. The surgical stapler further includes a drive member configured to translate distally and retract proximally through the end effector, and an actuating mechanism configured to translate the drive member distally through the end effector and retract the drive member proximally through the end effector. The staple cartridge includes a first upper portion configured to be assembled into the first jaw and a second lower portion configured to be assembled into the second jaw. The staple cartridge further includes a shuttle configured to engage with a series of staple drivers to discharge staples when the drive member translates distally. In an embodiment, the first upper portion and the second lower portion are connected by a connecting member, and the nail magazine is configured to be installed along the longitudinal axis of the end effector.

On the other hand, the jaw closing mechanism of a surgical stapler for applying sutures to tissue according to the present disclosure relates to a first link member and a second link member. The first and second link members are configured to rotate around a pair of pivot pins when a force is applied to the first and second link members. A pair of external pins are configured to fix the first and second link members to the first jaw and the second jaw. The first pair and the second pair of drive cables are configured to apply a force to the first and second links to cause rotation around the pivot pin. The jaw closing mechanism further includes a cam groove formed on one of the jaws, the cam groove being configured to receive the cam groove pin of at least one link member in the link member. The cam groove has a proximal portion for closing the jaws in parallel and a distal portion for closing the jaws at an angle.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other aspects, features and advantages of the present surgical instrument will become more apparent from the following detailed description taken in conjunction with the accompanying drawings, in which:

FIG1 is a perspective view of an illustrative surgical instrument according to the present disclosure;

FIG1A is a perspective view of a distal end portion of the surgical instrument of FIG1 , shown with an end effector mounted to an elongated shaft and a rear end mechanism configured to actuate the instrument;

FIG2 is an exploded perspective view of a stapler cartridge suitable for use with the surgical instrument of FIG1 ;

2A is a perspective view showing the installation of a staple cartridge into the surgical instrument of FIG. 1 ;

FIG. 2B shows a portion of an illustrative surgical instrument having a flexure latch according to the present disclosure;

FIG. 2C shows a portion of an illustrative staple cartridge suitable for use with the surgical instrument of FIG. 1 ;

FIG2D shows an illustrative jaw suitable for use with the surgical instrument of FIG1 having a hook configured to engage and retain the staple cartridge of FIG2C within the jaw;

FIG2E shows an exploded view of another illustrative jaw and staple cartridge suitable for use with the surgical instrument of FIG1 ;

FIG3 is a partial perspective view of a portion of the end effector with a new reload installed;

FIG4 is a perspective view of the distal end portion of the surgical instrument of FIG1 with the jaws in an angled open position;

FIG5 is a perspective view of the distal end portion of the surgical instrument of FIG1 with the jaws in a parallel position;

FIG6 is a perspective view of the distal end portion of the surgical instrument of FIG1 with the jaws in a fully closed position;

FIG7 is a cross-sectional perspective view of the jaw closure mechanism of the surgical instrument of FIG1;

FIG8 is a perspective view of the first and second links of the jaw closure mechanism;

FIG9 is a perspective view of a portion of the jaws of the surgical instrument of FIG1;

FIG10 is a perspective view of the articulation mechanism of the surgical instrument of FIG1 with parts removed to reveal the internal structure;

FIG11 is a perspective view of a shuttle of the surgical instrument of FIG1 ;

11A is a partial perspective view with parts removed showing an unfired staple cartridge installed in the surgical instrument of FIG. 1 ;

12 is a cross-sectional perspective view of the drive mechanism of the surgical instrument of FIG. 1 with parts removed, illustrating a drive member configured to be driven distally when actuated;

13 is a partial perspective view of a removed portion of the driven shuttle in contact with a portion of the staple driver when the staple driver moves distally upon actuation;

13A and 13B schematically illustrate the firing of staplers to capture sutures and form wallet lines;

FIG. 14 depicts an illustrative blood vessel that has been severed and secured with a series of staples in conjunction with a suture to form a purse string;

FIG. 15 depicts a locking mechanism suitable for use in the surgical instrument of FIG. 1 in a disabled configuration;

FIG. 16 depicts the locking mechanism of FIG. 15 in an activated configuration;

FIG. 17 illustrates a top view of an operating room employing a robotic surgical system utilizing aspects of the present disclosure; and

18 shows a simplified side view of a robotic arm assembly that may be used with various aspects of the present disclosure.

DETAILED DESCRIPTION

Specific embodiments of the present surgical instrument are described below with reference to the accompanying drawings; however, it should be understood that the disclosed embodiments are merely examples of the present disclosure and may be implemented in various forms. Therefore, the specific structural and functional details disclosed herein should not be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching those skilled in the art to variously employ the present disclosure in virtually any appropriate detailed structure. Well-known functions or configurations are not described in detail to avoid obscuring the present disclosure in any unnecessary detail.

Although the following disclosure is presented with respect to surgical instruments for forming purse strings, it should be understood that certain features of the presently described surgical instruments can be readily adapted for use with any type of surgical clamping, cutting, or sealing instrument. The surgical clamping and cutting instruments can be minimally invasive (e.g., laparoscopic) instruments or instruments used in open surgery.

In addition, the features of the presently described surgical stapling instruments can be readily adapted for use with surgical instruments activated using any technology within the capabilities of a person skilled in the art, such as, for example, manually activated surgical instruments, powered surgical instruments (e.g., electromechanically driven instruments), robotic surgical instruments, etc.

1 is a perspective view of an illustrative surgical instrument 100 according to an embodiment of the present disclosure, having a backend mechanism 120 and an end effector 110 mounted on an elongated shaft 106. The backend mechanism 120 generally provides a mechanical coupling between the drive tendons or cables of the instrument and the motorized shaft of the mechanical interface of the drive system. Further details of known backend mechanisms and surgical systems are described, for example, in U.S. Pat. No. 8,597,280, U.S. Pat. No. 7,048,745, and U.S. Pat. No. 10,016,244, each of which is hereby incorporated by reference in its entirety.

The actuation mechanism of surgical instrument 100 employs a drive cable used in conjunction with a system of motors and pulleys. Powered surgical systems, including robotic surgical systems, are well known that utilize drive cables connected to a system of motors and pulleys for various functions, including opening and closing of the jaws, and movement and actuation of the end effector. Further details of known drive cable surgical systems are described, for example, in U.S. Pat. No. 7,666,191 and U.S. Pat. No. 9,050,119, both of which are incorporated herein by reference in their entirety.

FIG. 1A shows a distal portion of a surgical instrument 100, which includes an end effector 110 defining a longitudinal axis X-X and having a first jaw 111, a second jaw 112, a staple cartridge 122, a U-shaped clamp 140 for mounting the jaws 111, 112 to the instrument, and an articulation mechanism such as a wrist 160. The first jaw 111 and the second jaw 112 are configured to move from an open position to a closed position. In the closed position, the jaws 111, 112 cooperate to clamp tissue.

FIG. 2 depicts a staple cartridge 122. In an embodiment, the staple cartridge 122 includes an upper portion 123 having a first side 123a and a second side 123b and a lower portion 124 having a first side 124a and a second side 124b. Each pair of first and second sides 123a, 123b and 124a, 124b is separated by a central knife channel 153. Each side 123a, 123b and 124a, 124b defines a tissue contact surface 198a, 198b and 198c, 198d having a staple holding cavity 128 and suture holding channels 159a-d formed therein (see also FIG. 3). In an embodiment, the tissue contact surfaces 198a-d may further include a protrusion (not shown) positioned around the staple receiving cavity 128. The protrusion helps to further secure the clamped tissue and resist movement caused by the forces that may be generated by the cutting and suturing of the clamped tissue. The staplers 126 are supported on corresponding stapler drivers 127 disposed within corresponding stapler receiving cavities 128 formed in the stapler cartridge 122. The stapler receiving cavities 128 may be cutouts substantially perpendicular to the longitudinal axis of the end effector 110 and similar in length to the desired size of the staplers 126 to be fired. Each stapler 126 includes a leg 157 and a back span 158. The suture retaining channels 159a-d extend substantially parallel to the longitudinal axis of the end effector 110 and are substantially aligned with the center of the stapler receiving cavities 128 so that when the staplers 126 are fired, the sutures 129a, 129b are captured at various locations between the staplers 126 and the tissue 197, as described in more detail below.

The upper portion 123 and the lower portion 124 of the staple cartridge 122 are configured to be received within the first jaw 111 and the second jaw 112, respectively. The side 123a of the upper portion 123 is connected to the side 124a of the lower portion 124 at the proximal end of the staple cartridge 122 by a living hinge 125a. Similarly, the side 123b of the upper portion 123 is connected to the side 124b of the lower portion 124 at the proximal end of the staple cartridge 122 by a living hinge 125b. The channels 159a, 159c of the sides 123a and 124a of the staple cartridge 122 extend to the living hinge 125a and are aligned with the living hinge channel 169a. Similarly, the channels 159b, 159d of the sides 123b and 124b of the staple cartridge 122 extend to the living hinge 125b and are aligned with the living hinge channel 169b. In this manner, sutures 129a, 129b may be directed from lower portion 124 to upper portion 123 on each side of the instrument to form loops when tissue is clamped and the surgical instrument is actuated.

The staple cartridge 122 may also include a shuttle 130 having an inclined distal portion 131 that sequentially acts on the staple drivers 127 when moving distally, camming them toward the grasped tissue, thereby forcing the staples toward the grasped tissue. The legs 157 of the staples 126 are located on either side of the sutures 129a, 129b and are configured to secure the sutures 129a, 129b to the grasped tissue when the surgical instrument is actuated. The details of the mechanism for forming the staples 126 for providing a purse string are described below (see FIGS. 13 and 13A).

In an embodiment, the upper portion 123 of the staple cartridge 122 includes a distal portion 190 that overlaps the distal portion 195 of the lower portion 124 when the jaws 111, 112 are closed. The distal portion 190 prevents the staple cartridge 122 from sliding out of the jaws after installation. The distal portion 190 may include a deflected latch member 192 that will engage with a recess (not shown) contained in the jaws 111 when the staple cartridge 122 is installed in the jaws 111, 112, holding the latch member 192 in place until it is broken by releasing it by applying finger pressure. The deflection will provide an eccentric snap feel between the latched position and the unlatched position, so that the surgeon will be able to feel the difference between the latched position and the unlatched position. It is foreseeable that the latch 192 can be held in place by any number of desired mating features, such as a protrusion or cutout formed on the jaws 111. 2C-2D , the staple cartridge 122 can further include a notch 199a configured to engage at least one hook 199b received within the jaws 111, 112. When installed, the staple cartridge 122 can be slightly pivoted so that the hook 199b snaps into the recess 199a, thereby helping to hold the staple cartridge 122 in place.

The distal portion 129c of the suture 129a extends beyond the distal ends of the suture retaining grooves 159a and 159c, and the distal portion 129d of the suture 129b extends beyond the distal ends of the suture retaining grooves 159b and 159d. Thus, the suture 129a can, for example, extend from the distal portion 190, extend proximally in the channel 159a within the side 123a of the upper portion 123 of the staple cartridge 122, pass through the living hinge channel 169a around the living hinge 125a, and then extend distally along the suture channel 159c of the side 124a of the lower portion 124 of the staple cartridge 122. The staple cartridge 122 is mounted in a direction substantially parallel to the longitudinal axis of the end effector 110 and inserted in the direction of arrow A from the distal end of the surgical instrument 100 toward the proximal end of the surgical instrument 100, as shown in FIG. 2A. In alternative embodiments, it is contemplated that the stapler may allow for installation of the staple cartridge 122 in a radial direction that is substantially orthogonal to the longitudinal axis of the end effector 110. FIG2E shows an illustrative jaw 112 configured to allow for radial installation of the staple cartridge 122. The hooks 199b on the staple cartridge may engage the recesses 199a formed on the jaw 112 to help retain the staple cartridge 122 within the jaw 111 in a manner similar to the previous embodiments.

As can be seen in FIG. 3 , when a new, unfired staple cartridge 122 is installed, the shuttle 130 prevents the unwanted separation of the sides 123a and 123b of the upper portion 123 of the staple cartridge 122 and the sides 124a and 124b of the lower portion 124 of the staple cartridge 122. In addition, the staple cartridge 122 includes a protrusion 121 configured to slide into a slot 113 formed on the jaws 111, 112. The slot 113 of the jaws 111, 112 serves as a guide for the protrusion 121 to ensure proper alignment when a new staple cartridge 122 is installed. In addition, during installation and firing, the interaction of the staple cartridge protrusion 121 and the slot 113 limits the upward and downward movement of the staple cartridge 122.

4-6 depict the movement of the jaws 111 , 112 as the instrument is closed in preparation for actuation.

In Fig. 4, jaws 111, 112 are in an open position, similar to a grabber, and in an angled closed area. As shown in Fig. 5, jaws 111, 112 are closed at an angle until they are substantially parallel. Once jaws 111, 112 are substantially parallel, they continue to close while remaining substantially parallel to compress tissue. Once closed around tissue, the instrument can be fired to cut and insert staples into the grasped tissue while sutures 129a, 129b are captured by the staples, thereby forming a wallet line around the clamped tissue. The mechanism of jaw opening and closing is described in more detail below.

7 illustrates a portion of a surgical instrument 100 configured to open and close jaws including a clevis 140 , a first linkage member 145 , a second linkage member 146 , and drive cables 170 a , 170 b .

As shown in FIG. 7 , two drive cables 170a, 170b symmetrically travel to the rear end of the surgical instrument 100 and terminate in a knot 172 within the proximal end 141 of the first link member 145. When the cables 170a, 170b are pulled by the force of a motor (not shown) or via some other mechanism, the first link member 145 rotates around the pivot pin 143 on the U-shaped clamp 140, causing the second link member 146 to rotate around the pivot pin 144 on the U-shaped clamp 140, thereby moving the jaws toward an open or closed position depending on which drive cable is pulled. The resulting jaw force is substantially similar to the pulling force of the cables. It will be understood by a person of ordinary skill that there can be a pair of drive cables on each side of the surgical instrument 100, each pair of drive cables including a first cable for closing the first link and a second cable for opening the first link. A total of four cables are used to open and close the jaws, which reduces the stress on each cable and allows the cable forces through wrist 160 to be balanced symmetrically so that actuating the jaws does not apply pitch or yaw forces to the wrist (see FIG. 10 ).

As shown in FIGS. 8 and 9 , the link member 145 includes an upper outer pin 148a, and the link member 146 includes a lower outer pin 148b. The upper outer pin 148a is configured to be positioned within the opening 114 of the jaw 111, while the lower outer pin 148b is configured to be positioned within the opening 115 of the jaw 112 (e.g., see FIGS. 1A and 4-6 ). The link member 145 also includes a cam groove pin 149a, which is configured to engage and ride within a cam groove 118 formed on the jaw 111. The cam groove 118 is designed so that the proximal portion 118a of the cam groove 118 allows parallel closure of the jaw 111, while the distal portion 118b of the cam groove 118 allows angled closure of the jaw 111 when the link members 145, 146 are rotated due to the force of the drive cables 170a, 170b when the surgical instrument is actuated. Similar to the link members 145, 146, a second set of link members 145a, 145b and corresponding openings and cam slots are present on the distal side of the jaws 111, 112 of the clevis 140 and act similarly to the link members 145, 146. The link members 145, 146 also include gear teeth 147 to force equal symmetrical movement of the jaws 111, 112.

FIG. 10 shows an articulated mechanism including an articulated wrist 160 and drive cables 170c, 170d extending from the proximal end of the instrument to wrist links 162, 164. The wrist 160 includes a plurality of links that provide a desired amount of motion, such as +/-90 degrees in pitch or yaw. In an embodiment, a single joint can provide an angular deflection of up to 90 degrees. According to an exemplary embodiment, the wrist may include a plurality of links to achieve a higher range of motion, such as, for example, a wrist having a range of motion of up to +/-180 degrees in pitch or yaw. Typically, an actuating element such as, for example, a pull/pull tendon or a push rod/pull rod and an electrical conductor connected to the wrist and/or end effector of the instrument may extend through the elongated shaft of the instrument. In addition, the actuating element may extend through the elongated shaft and be connected to a transmission mechanism that typically provides a mechanical coupling of the drive tendon to drive the motor. As described above, the surgical instrument 100 may include two pairs of drive cables for opening and closing the jaws, reducing the stress on each cable and allowing symmetrically balanced cable forces through the wrist 160 so that actuating the jaws does not apply pitch or yaw forces to the wrist. In addition, it is foreseeable that the cables can be merged within the middle portion of the surgical instrument 100 so that only two cables are present at the input capstan (not shown). This type of merging allows the pulleys to maintain cable length savings when the wrist pitches or yaws. Additional details of other joints and wrist actuation elements that can be used with the embodiments disclosed herein are disclosed in International Publication WO 2015/127250A1, the entire disclosure of which is incorporated herein by reference.

FIG. 11 and FIG. 11A show shuttles 130 housed in a staple cartridge 122. Each shuttle 130 has a body 135 including an inclined distal portion 131 and wings 137, 138. The shuttle 130 is positioned in each of the upper portion 123 and the lower portion 124 of the staple cartridge 122 and prevents the first side 123a and the second side 123b of the upper portion 123 and the first side 124a and the second side 124b of the lower portion 124 from opening during processing to ensure that the staple cartridge 122 fits within the slot 113 of the jaws 111, 112 (see FIG. 11A). During the distal movement of the shuttle 130, the inclined distal portion 131 sequentially acts on the staple drivers 127, camming them upward, thereby forcing the staples 126 through the staple receiving chamber 128. The shuttle 130 also includes a proximal surface 132 that may be substantially perpendicular to the axis of the end effector 110. The leading edge 133 of the shuttle 130 gathers tissue toward the central knife channel 153 so that the tissue can be severed with the knife 151 (see FIG. 13). The shuttle 130 also includes an inner edge 134 (see FIG. 15) which is described in more detail below.

12-13 illustrate distal translation of components of the surgical instrument 100 when actuated to sever and insert staples into clamped tissue such that a purse-string is formed by the sutures 129a, 129b.

FIG. 12 shows a drive member 150 having an integrated blade 151, a shuttle 130, a U-clip 140, and a drive rod 155. When the surgical instrument 100 is actuated, the drive member 150 is pushed distally or pulled proximally through the central knife channel 153 of the staple cartridge 122 by the drive rod 155 fixed to the proximal cutout 154 formed on the drive member 150. The drive member 150 can be coupled to any known actuation mechanism, including a manually actuated actuator, a motor-driven or power-driven actuator, or other types of actuation mechanisms. The drive member 150 includes a distal edge 152 that is substantially aligned with the proximal side 132 of the shuttle 130. When the surgical instrument 100 is actuated, the distal edge 152 of the drive member 150 engages with the proximal side 132 of the shuttle 130, thereby causing the shuttle 130 to translate distally. Drive member 150 also includes a knife edge 151 located between distal edges 152 for severing clamped tissue as drive member 150 translates distally through central knife channel 153 during firing of surgical instrument 100. The central location of knife channel 153 ensures that knife edge 151 severs tissue adjacent to and between two portions of tissue being stapled and sutured (see FIG. 14 ).

FIG. 13 shows the shuttle 130 traveling distally during the firing of the surgical instrument 100. In FIG. 13, the inclined distal portion 131 of the shuttle 130 has fully deployed the first stapler 126a and is engaged with the second stapler driver 127 to deploy the second stapler 126b. As shown in FIG. 13A and FIG. 13B, first, each stapler 126 is pushed under the force of the stapler driver 127 applied to the rear span 158 of the stapler, while the lateral force is simultaneously applied to the legs 156 by the lip 157 of the stapler receiving cavity 128, so that the legs 156 begin to deform and move relative to each other when penetrating into the tissue 197. As shown in FIG. 13B, near the end of each stroke of the stapler driver 127, the legs 156 of the staplers have been substantially deformed so as to be in a cross relationship with each other. In this position, the staplers will not be easily pulled out of the tissue 197. At the same time, the sutures 129a, 129b are pushed out of the channels 159a-d and captured between the deformed staplers 126 and the tissue 197. As they are retained within the deformed staplers 126, the sutures 129 form purse strings.

FIG. 14 depicts an illustrative blood vessel or tissue that has been severed and stapled with a surgical instrument according to the present disclosure. Sutures 129a, 129b are secured to the tissue in a wallet-line format, with staples 126 holding sutures 129a, 129b in place. Once secured, another tool may be used to tighten the wallet line by pulling ends 129c, 129d. In an embodiment, clips 165a, 165b may be preloaded into the distal end of staple cartridge 122 and secured to ends 129c, 129d of sutures 129a, 129b, and used to allow the surgeon to manually tie the wallet line to hold sutures 129a, 129b in a tightened configuration.

15 and 16 illustrate a locking mechanism that may be used with a surgical instrument according to an embodiment of the present disclosure.

In FIG. 15 , a disabled locking mechanism is shown. The locking member 180 has an engagement portion 181 on the distal end of the locking member 180 and a proximal portion 182 on the proximal end of the locking member 180. In an embodiment, the distal portion 181 of the locking member 180 is shaped like a hook. In an embodiment, the locking member 180 is formed by a spring wire. When an unfired nail cartridge is installed, the inner edge 134 of the shuttle 130 contacts the engagement portion 181 of the locking member 180, causing it to be misaligned with the distal edge 152 of the drive member 150. In this position, the drive member 150 can be translated distally, allowing the user to actuate the instrument.

FIG. 16 shows the locking mechanism activated. The locking member 180 is designed so that the engagement portion 181 is biased toward a position that aligns the engagement portion 181 with the distal edge 152 of the drive member 150. As can be seen in FIG. 16, when the shuttle 130 moves and the inner edge 134 of the shuttle 130 no longer contacts the locking member 180, the engagement portion 181 of the locking member 180 moves back to its naturally biased position, in which it aligns with the distal edge 152 of the drive member 150. Once the instrument is fired and retraction of the drive member 150 occurs, the user may not fire the instrument again without installing a new unfired staple cartridge because unless a new staple cartridge is installed, the distal edge 152 will contact the engagement portion 181 of the locking member 180 and will prevent the drive member 150 from translating distally and the jaws have been sufficiently closed so that they are parallel and clamped on the tissue.

The present surgical instrument for applying one or more purse-string sutures can be used in a robotic surgical system. As an example, FIG. 17 shows a top view of an operating room employing a robotic surgical system. In this case, the robotic surgical system is a robotic surgical system 300 that includes a control console ("C") used by a surgeon ("S"), while typically with the assistance of one or more assistants ("A"), to perform a minimally invasive diagnostic or surgical procedure on a patient ("P") lying on an operating table ("O").

The console includes a monitor 304 for displaying an image of the surgical site to the surgeon, left and right manipulable control devices 308 and 309, a foot pedal 305, and a processor 302. The control devices 308 and 309 may include one or more of any of a variety of input devices, such as a joystick, a glove, a trigger gun, a hand controller, etc. The processor 302 may be a dedicated computer that may be integrated into the console or located next to it.

The surgeon performs a minimally invasive surgical procedure by manipulating control devices 308 and 309 (also referred to herein as “master manipulators”) such that the processor 302 causes their respective associated robotic arm assemblies 328 and 329 (also referred to herein as “slave manipulators”) to respectively manipulate their respective detachably coupled surgical instruments 338 and 339 (also referred to herein as “tools”), while the surgeon views the surgical site in 3D on the console monitor 304 as captured by the stereo endoscope 340.

Each of tools 338 and 339 and endoscope 340 can be inserted into the patient through a cannula or other tool guide (not shown) so as to extend downward to the surgical site through a corresponding minimally invasive incision, such as incision 366. Conventionally, each of the plurality of robotic arms is formed by links, such as link 362, which are coupled together and manipulated by motor-controlled or movable joints, such as joint 363.

The number of surgical tools used at one time, and therefore the number of robotic arms used in system 300, will generally depend on the diagnostic or surgical procedure and the space limitations within the operating room, among other factors. If it becomes necessary to replace one or more of the tools being used during a procedure, the assistant can remove the tool no longer in use from his robotic arm and replace it with another tool 331 in the operating room tray ("T").

Monitor 304 can be positioned near the surgeon's hands so that it will display a projected image oriented to make the surgeon feel that he or she is actually looking directly down at the surgical site. To this end, the images of tools 338 and 339 may appear to be located substantially where the surgeon's hands are.

Processor 302 performs various functions in system 300. One important function it performs is to convert and transmit the mechanical motion of control devices 308 and 309 to their respective robotic arms 328 and 329 via control signals on bus 310 so that surgeons can effectively manipulate their respective tools 338 and 339. Another important function is to implement the various control system processes described herein.

Although described as a processor, it should be understood that the processor 302 can be implemented in practice by any combination of hardware, software and firmware. In addition, its functions described herein can be performed by one unit, or divided between different components, each of which can be implemented in turn by any combination of hardware, software and firmware.

For additional details on robotic surgical systems, see, for example, U.S. Patent Nos. 6,493,608 and 6,671,581, the entire contents of which are incorporated herein by reference.

As an example, FIG. 18 shows a side view of a simplified (not necessarily to scale or complete) illustrative robotic arm assembly 400 (representing robotic arm assemblies 328 and 329) holding a surgical instrument 450 (representing tools 338 and 339) for performing a surgical procedure. The surgical instrument 450 is removably held in a tool holder 440. The arm assembly 400 is mechanically supported by a base 401, which can be part of a patient-side mobile cart or fixed to an operating table or ceiling. It includes links 402 and 403 coupled together and coupled to the base 401 by providing joints 404 and 405.

In this example, setting joints 404 and 405 are passive joints that allow manual positioning of arm 400 when the brakes are released. For example, setting joint 404 allows manual rotation of link 402 around axis 406, while setting joint 405 allows manual rotation of link 403 around axis 407.

Although only two links and two setup joints are shown in this example, more or less of each link may be used appropriately in this and other robotic arm assemblies in conjunction with the present invention. For example, although setup joints 404 and 405 are useful for horizontal positioning of arm 400, additional setup joints may be included and useful for limited vertical and angular positioning of arm 400. However, for primarily vertical positioning of arm 400, arm 400 may also be slidably moved along the vertical axis of base 401 and locked in place.

The robotic arm assembly 400 also includes three movable joints driven by motors. The yaw joint 410 allows the arm segment 430 to rotate about an axis 461, while the pitch joint 420 allows the arm segment 430 to rotate about an axis perpendicular to the axis 461 and orthogonal to the plane of the drawing. The arm segment 430 is configured so that when the pitch joint 420 is rotated by its motor, the segments 431 and 432 are always parallel to each other. As a result, the instrument 450 can be controllably moved by driving the yaw motor and the pitch motor so as to pivot about a pivot point 462, which is typically placed by setting manual positioning of the joints 404 and 405 so that it is located at the incision point of the patient. In addition, the insertion gear 445 can be coupled to a linear drive mechanism (not shown) to extend or retract the instrument 450 along its axis 463.

Although each of the yaw, pitch, and insertion joints or gears 410, 420, and 445 are controlled by a separate joint or gear controller, the three controllers are controlled by a common master/slave control system such that the robotic arm assembly 400 (also referred to herein as a "slave manipulator") can be controlled by a user (e.g., a surgeon) manipulating its associated master manipulator.

Although several embodiments have been shown in the accompanying drawings, it is not intended that the disclosure be limited thereto, as the intention is that the scope of the disclosure be as broad as the art will allow, and the specification be read as such. Therefore, the above description should not be construed as limiting, but merely as examples of the presently disclosed embodiments. Accordingly, the scope of the embodiments should be determined by the appended claims and their legal equivalents, rather than by the examples given.

Those skilled in the art will appreciate that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. Features shown or described in conjunction with an exemplary embodiment may be combined with features of other embodiments. Various alternatives and modifications may be devised by those skilled in the art without departing from the present disclosure. Therefore, the present disclosure is intended to cover all such alternatives, modifications and variations. Similarly, based on the above-described embodiments, those skilled in the art will appreciate other features and advantages of the present disclosure. Therefore, except as indicated by the appended claims, the present disclosure is not limited to what has been specifically shown and described.

Claims (25)

1. A surgical stapling instrument, comprising:

An elongate shaft having a distal end and a proximal end;

An end effector coupled to the distal end of the shaft and comprising a first jaw and a second jaw;

A first row of staples in the first jaw;

a second row of staples in the second jaw;

a suture extending through the first and second rows of staples; and

A drive member configured to translate distally through the end effector to drive the first and second rows of staples into tissue such that the suture is disposed between the first and second rows of staples and the tissue.

2. The surgical stapling instrument of claim 1 or 18, wherein said end effector comprises a longitudinal axis, said instrument further comprising a third row of staples in said first jaw on an opposite side of said longitudinal axis from said first row of staples.

3. The surgical stapling instrument of claim 2, further comprising a fourth row of staples in said second jaw on an opposite side of said longitudinal axis from said second row of staples.

4. The surgical stapling instrument of claim 3 wherein said suture is a first suture extending through said first and second rows of staples, said instrument further comprising a second suture extending through said third and fourth rows of staples.

5. The surgical stapling instrument of claim 1, further comprising a cutting element coupled to said drive member and configured to dissect tissue as said drive member translates distally through said first jaw and second jaw, wherein said second row of staples comprises at least two rows of linear staples.

6. The surgical stapling instrument of claim 1 or 13, further comprising a staple cartridge detachably coupled to said first jaw and said second jaw, wherein said staple cartridge comprises a first portion and a second portion, and wherein said first jaw comprises a first channel for receiving said first portion and said second jaw comprises a second channel for receiving said second portion.

7. The surgical stapling instrument of claim 6, wherein said first channel and said second channel each have a distal opening for receiving said first portion and said second portion of said staple cartridge.

8. The surgical stapling instrument of claim 6, wherein said staple cartridge further comprises a distal portion configured to retain said first portion and said second portion of said staple cartridge in said first jaw and said second jaw.

9. The surgical stapling instrument of claim 5, wherein said staple cartridge comprises a first shuttle in said first portion and a second shuttle in said second portion, wherein said first shuttle and said second shuttle each comprise an angled distal portion for engaging said staples such that said suture in combination with said staples forms a purse string with said tissue.

10. The surgical stapling instrument of claim 5, further comprising a connecting member between said first portion and said second portion of said staple cartridge.

11. The surgical stapling instrument of claim 6, wherein said connecting member comprises a channel for receiving said suture, wherein said channel is configured to form said suture into a loop.

12. The surgical stapling instrument of claim 1 or 13, further comprising:

an actuation mechanism configured to translate the drive member distally through the end effector; and

An actuator operably connected to the actuation mechanism, wherein the actuator comprises a control device of a robotic surgical system.

13. A surgical stapling instrument, comprising:

an elongate shaft having a distal end and a proximal end;

An end effector having first and second jaws configured to receive a staple cartridge, wherein at least one of the jaws is movable between an open position, in which the jaws define an angle therebetween, to a partially closed position, in which the jaws are substantially parallel to one another and define a first gap therebetween; and

A drive member configured to translate distally through the end effector to apply staples and sutures to tissue, wherein the drive member moves the jaws to a closed position in which the jaws are substantially parallel to one another and define a second gap therebetween, wherein the second gap is less than the first gap.

14. The surgical stapling instrument of claim 13, wherein said jaws contact one another in said closed position.

15. The surgical stapling instrument of claim 13, wherein at least one of said first jaw and said second jaw comprises a cam slot having a proximal portion for closing said jaws in parallel and a distal portion for closing said jaws at an angle.

16. The surgical stapling instrument of claim 15, further comprising:

At least one link member configured to rotate about at least one pivot pin upon application of a force to the link member; and

A cam slot pin extending from the link member and through the cam slot, wherein the cam slot pin is configured to translate through the cam slot upon rotation of the link member.

17. The surgical stapling instrument of claim 15, wherein said end effector defines a longitudinal axis, and wherein said distal portion of said cam slot extends at a transverse angle to said longitudinal axis, and said proximal portion of said cam slot is substantially parallel to said longitudinal axis.

18. The surgical stapling instrument of claim 13, further comprising:

A first row of staples in the first jaw;

a second row of staples in the second jaw; and

A suture extending through the first and second rows of staples.

19. The surgical stapling instrument of claim 13, further comprising an actuation mechanism configured to translate said drive member distally through said end effector, wherein said actuation mechanism is configured to translate said drive member distally after said first jaw and said second jaw are in said partially closed position.

20. The surgical stapling instrument of claim 19, wherein said actuation mechanism is configured to distally translate said drive member after said first jaw and said second jaw are closed on tissue.

21. A surgical stapling instrument, comprising:

An elongate shaft having a distal end and a proximal end;

An end effector coupled to the distal end of the shaft and comprising a first jaw and a second jaw, wherein at least one of the jaws is movable between an open position and a closed position;

A coupling member coupling the end effector with the shaft, the coupling member including a first link member and a second link member; and

A first force transmitting member and a second force transmitting member extending through the shaft and coupled to the first link member, wherein axial movement of the first link member and the second link member rotates the first link member, wherein rotation of the first link member causes rotation of the second link member to move the jaws between the open position and the closed position.

22. The surgical stapling instrument of claim 21, further comprising a first pivot pin and a second pivot pin on said coupling member, wherein said first link member is rotatable about said first pivot pin and said second link member is rotatable about said second pivot pin.

23. A surgical stapling instrument, comprising:

An elongate shaft having a distal end and a proximal end;

An end effector coupled to the distal end of the shaft and comprising a first jaw and a second jaw, wherein at least one of the jaws is movable between an open position and a closed position;

a staple cartridge comprising a plurality of staples and a staple driver; and

A shuttle comprising a body and laterally extending first and second wings, wherein each of the first and second wings comprises a sloped distal portion configured to engage the staple driver when the shuttle is translated distally.

24. The surgical stapling instrument of claim 23, further comprising:

a drive member configured to translate distally through the staple cartridge;

a locking member movable between a first position allowing distal translation of the drive member and a second position prohibiting distal translation of the drive member; and

Wherein the shuttle includes an inner edge configured to engage the locking member to retain the locking member in the first position.

25. A robotic surgical system, comprising:

A surgical instrument comprising an elongate shaft having a distal end and a proximal end, an end effector coupled to the distal end of the shaft and comprising a first jaw and a second jaw, at least one row of staples in the first jaw or the second jaw, a suture extending through the row of staples, and a drive member configured to translate distally through the end effector to drive the row of staples into tissue such that the suture is disposed between the row of staples and the tissue;

a robotic arm configured for coupling to the surgical instrument;

A control device remotely spaced from the robotic arm and movable to provide a desired motion of the robotic arm and the surgical instrument; and

A controller configured to control the robotic arm based on movement of the control device.